Francesca M Trovato1, Sebastiana Atzori2, Giuseppe Musumeci3, Vanessa Tooley4, Heather Marcinkowski4, Mary M E Crossey4, Nimzing G Ladep4, Giuseppe F Martines5, Robert D Goldin6, Simon D Taylor-Robinson4. 1. Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Catania, Italy; Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK. Electronic address: trovatofrancesca@gmail.com. 2. Department of Clinical and Experimental Medicine, University of Sassari, Azienda Ospedaliero Universitaria, Sassari, Italy; Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK. 3. Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy. 4. Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK. 5. Emergency Department, MCAU, Vittorio Emanuele Hospital, Catania, Italy. 6. Department of Histopathology, Imperial College Faculty of Medicine at St Mary's Hospital, London, UK.
Abstract
PURPOSE: The estimation of the degree of liver fibrosis is important for prognosis, surveillance, and treatment of chronic liver disease. Although liver biopsy is the gold standard for diagnosis, it is subject to sampling error, while ultrasound-based techniques, such as Acoustic Radiation Force Impulse (ARFI) and transient elastography, have gained popularity. However, no previous comparative study has performed these ultrasound techniques at the time of biopsy. The aim of this study was to compare the reliability of these techniques to define the severity of liver fibrosis in viral hepatitis patients. PATIENTS AND METHODS: We compared liver transient elastography and Acoustic Radiation Force Impulse measurements, performed along the intended biopsy track, with liver biopsy results in 46 viral hepatitis patients, all measured on the same morning. Fibrosis was measured by histology using the Ishak fibrosis staging. RESULTS: The relative sensitivity and specificity of different incremental cut-off values for both techniques, and the predictive ability of pairwise comparison of the 3 tests (including APRI) and of their combined use with more severe grades of histology-measured liver fibrosis, show that the single variable with greatest sensitivity and specificity is TE with a cut-off of >10.0. CONCLUSION: Transient elastography has a better performance than ARFI, which has a lower sensitivity, in the diagnosis of severe stages of fibrosis. Also ARFI of the spleen is correlated with Ishak fibrosis staging, and could be a possible additional tool for the diagnosis of liver fibrosis.
PURPOSE: The estimation of the degree of liver fibrosis is important for prognosis, surveillance, and treatment of chronic liver disease. Although liver biopsy is the gold standard for diagnosis, it is subject to sampling error, while ultrasound-based techniques, such as Acoustic Radiation Force Impulse (ARFI) and transient elastography, have gained popularity. However, no previous comparative study has performed these ultrasound techniques at the time of biopsy. The aim of this study was to compare the reliability of these techniques to define the severity of liver fibrosis in viral hepatitispatients. PATIENTS AND METHODS: We compared liver transient elastography and Acoustic Radiation Force Impulse measurements, performed along the intended biopsy track, with liver biopsy results in 46 viral hepatitispatients, all measured on the same morning. Fibrosis was measured by histology using the Ishak fibrosis staging. RESULTS: The relative sensitivity and specificity of different incremental cut-off values for both techniques, and the predictive ability of pairwise comparison of the 3 tests (including APRI) and of their combined use with more severe grades of histology-measured liver fibrosis, show that the single variable with greatest sensitivity and specificity is TE with a cut-off of >10.0. CONCLUSION: Transient elastography has a better performance than ARFI, which has a lower sensitivity, in the diagnosis of severe stages of fibrosis. Also ARFI of the spleen is correlated with Ishak fibrosis staging, and could be a possible additional tool for the diagnosis of liver fibrosis.
Authors: Ayesha K Ahmad; Sebastiana Atzori; Simon D Taylor-Robinson; James B Maurice; Graham S Cooke; Lucy Garvey Journal: Medicine (Baltimore) Date: 2019-11 Impact factor: 1.817